Healthcare Provider Details

I. General information

NPI: 1073833307
Provider Name (Legal Business Name): KENNETH KALADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 RTE 33 UNIT 4
FARMINGDALE NJ
07727-4033
US

IV. Provider business mailing address

1306 RTE 33 UNIT 4
FARMINGDALE NJ
07727-4033
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-5545
  • Fax: 732-938-5540
Mailing address:
  • Phone: 732-938-5545
  • Fax: 732-938-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12788
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number288RI012788
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: